Dissector-obstructor apparatus



March 30, 1965 E. WOOD ET-AL DISSEGTOR-OBSTRUCTOR APPARATUS Filed July26, 1960 I N VEN TORS Frankel United States Patent 3,175,556DISSECTOR-OBSTRUCTOR APPARATUS Ernest Wood and Amotz Frenkel, LosAngeles, Calif., assignors of twenty-five percent to Peter B. Samuel andtwenty-five percent to Rene G. Le Vaux Filed July 26, 1960, Ser. No.45,446 6 Claims. (Cl. 128-305} This invention relates in general tosurgical devices and more specifically relates to a system, apparatus,and arrangements for clamping and severing blood vessels.

In essence the present invention incorporates a novel blood vessel clampstructure, a device by means of which the clamp structure is applied toa blood vessel and the vessel severed whereafter the device isdisengaged while the severed ends are retained closed to blood flow.

One of the severe problems in surgical procedures arises from thenecessity to sever various blood vessels while preventing excessiveblood flow from the severed ends so that subsequent operative steps maybe taken immediately. In approaching this problem many procedures havebeen derived, all of which are complex and have required cumbersomeapparatus, time consuming procedures, and skillful manipulations. As maybe appreciated, the time presently involved in clamping numerous bloodvessels and the skill necessary to perform the same may in certain casespreclude a necessary operation or restrict the number of persons capableof performing the same. In addition, any delay or error during thecourse of an operation may have complicating or serious consequences andthe possibility of such occurring, of course, multiplies with the numberof vessels that must be clamped and the consequent length of theoperation, wherefore it is exceedingly important to both reduce the timeinvolved in clamping and severing blood vessels and eliminate the needfor exacting. and cumbersome manipulations.

To solve these problems, at least one and preferably a pair of clampsare provided which can be held within the jaws of a scissors orpliers-like instrument called a dissector-obstructor and which is in thenature of a hemostat. The instrument, hereinafter referred to as thedissector or dissector-obstructor will be described in its preferredpractice for use with a pair of spaced clamps but it will be understoodthat it can be equally employed for strangulation of a blood vessel withbut a single clamp. The instrument is operated for squeezing the clampsupon the blood vessel to close the blood vessel at two differentlocations whereafter a knife carried by the dissector is operated todissect or sever the blood vessel between the two clamped portions. Thedissector is then removed to enable another vessel to be severed in alike manner, while the clamps continue to hold the severed ends of thevessel closed.

As may be appreciated, the clamps are of comparatively minute dimensionsand comprise a configuration of novel design whereby they may bereceived and carried by the dissector, applied to a blood vessel, andoperated into a clamping position to maintain the blood vessel clamped,and thereafter disengaged from the dissector to permit the dissector tobe usedagain for clamping another vessel.

The dissector in turn is of an unsual design that permits the clamps tobe carried in a novel posture whereby they are placed in a semi-circlingposition about a blood vessel, and operated to clamp the vesselwhereafter a knife blade carried by the dissector is operatedto descendbetween the clamps for severing the blood vessel; The dissector is thenwithdrawn leaving thevessel clamped and in turn engaged with a novelloading structure with which it cooperates to be recharged with clampsfor a succeeding clamping and severing operation,

It may be seen from the above description that the entire process ofclamping the severing blood vessels has both been simplified andaccelerated.

After the dissector is charged, the surgeon simply en-' gages the jawscarrying the clamps with a blood vessel to be clamped and operates thedissector to squeeze the clamps tightly over the vessel. The jaws arelatched in a position dependent on the pressure exerted thereon topermit the surgeon to operate a knife lever carried by the dissectorwhile the jaws are latched. The knife lever is operated to sever thevessel and the dissector thereafter unlatched and withdrawn to bereinserted in the loading device for another charge of clamps.

The entire procedure is simplicity itself and one that permits a greatnumber of vessels to be quickly and securely tied or clamped within aminimum time period and with practically no training in the use of theequipment, thereby largely eliminating the need for complex, skillful,time consuming manual manipulation.

It is therefore an object of the present invention to provide adissector-obstructor for use in surgical operations.

It is another object of this invention to provide an improved hemostatwhich functions to both clamp a blood vessel and sever the blood vesseland/ or permit the re moval of the hemostat while the vessel remainsclamped.

It is another object of the present invention to provide an improvedclamp structure for blood vessels.

It is another object of this invention to provide a clamp structurewhich may be carried into engagement with a blood vessel clamped inposition on the blood vessel and thereafter disengage from thedissector.

With the foregoing and other objects in view which will appear as thedescription proceeds, the invention comprises a novel system and certainnovel features of construction, arrangement and combination of parts areprovided hereinafter fully described, illustrated in the accompanyingdrawings, and particularly pointed out in the appended claims, it beingunderstood that various changes in the form, proportion, size and minordetails of the structure may be made without departing from the spiritor sacrificing any of the advantages of the invention.

For the purpose of facilitating an understanding of this invention,there is illustrated in the accompanying drawings a prefer-redembodiment thereof, from an inspection of which, when considered inconnection with the following description, this invention, its mode ofconstruction, assembly and operation, and many of its advantages shouldbe readily understood and appreciated.

In the drawings:

FIG. 1 is a side elevation of the dissector-obstructor;

FIG. 2 is a sectional view taken along the line 22 in FIG. 1 toillustrate the jaw section of the dissector poised for clamping a bloodvessel;

FIG. 3 is a side elevation taken along the line 3-3 in FIG. 2 for thesimilar purpose;

FIG. 4 is a view similar to FIG. 1 with the exception that the dissectoris shown in clamping position and partially broken away to illustratecertain internal constructions;

FIG. 5 is a sectional view taken along the line 5-5 in PEG. 4, but withthe knife blade operated to sever a clamped vessel;

FIG. 6 is .a side sectional view of one jaw showing a clamp insubstantially its clamping position;

FIG. 7 is a perspective view showing the blood vessel clamped and theknife poised to'sever the same;

FIG. 8 is a partial view showing the manner in which the dissector latchoperates.

Referring now to FIG. 1 it will be seen that the dissector general-lyindicated at 30 comprises a pair ofelonv2 j gate lever elements 32 and40 joined by a pivot pin 52 to permit a scissors or pliers-like movementof the respective jaws 61 and 60. As may be seen in FIG. 4, pin 52 isengaged in a slot 53 extending through a narrowed portion 39 of element32 behind its jaw 61 for a purpose which will become apparent. The pin52 is mounted between the two arms 41 of a bifurcated portion extendingfrom lever element 46 to its jaw 60. This bifurcated portion alsoengages the narrowed portion 39 having slot 53 therein. At one end ofthe members 32 and 40 are respective finger grips 34 and 42 arranged toreceive, for example, a thumb and forefinger respectively to permitmanipulation or pivoting of elements 32 and 46 For some persons, ofcourse, the index finger is used in preference to the forefinger, thusleaving the forefinger free to operate the knife lever 49, to bedescribed. Adjacent each finger grip 32 and 42 and projecting towardeach other are latch elements 36 and 38 respectively each carrying aseries of opposing serrations, detents, teeth, or steps 37 and 37*respectively. The elements 36 and 38 each have a respectivebeveled orrounded end 43 thereon, as seen in FIG. 8, which permits the elements 36and 38 to be transversely displaced for engaging each other as themembers 32 and 40 are moved towards each other. This enables any one ofthe steps 37 to engage with respective steps 37 as shown in FIGS. 4 and8 to hold elements 32 and 40 in a desired one of a plurality of operatedclamping positions.

Each element 40 and 32 carries at its other end a respective jaw 66 and6-]. already mentioned. The jaws 60 and 61 are each provided with pairsof spaced apart recesses 64 eaoh recess in facing relationship to arespective recess in the other jaw. The jaws 60 and 61 are adapted toengage a clamp 20 between each pair of facing recesses as seen in F168.2, 3 and 5. Between the spaced apart recesses in each jaw there is anaperture 58 and 59 respectively each arranged to receive the knife blade54. The aperture 59 in the jaw 61 is actually a slot that extends to theend of the jaw 61 to permit the knife blade 54. and the integrallyformed stop 55 carried thereon to completely descend th'erethrough. Theaperture 58 in the other jaw 60 is dimensioned to just accommodate theblade 54 and is extended as a recess 62 to the end of jaw 60 as perhapsbest seen in FIGS. '2 and 4. This permits the top Wall of recess 62 toengage stop 55 while enabling the knife edge formed on the bottom ofknife 54 and the stop 55 to be withdrawn into a safe position. 7

The knife blade 54 is carried by a knife lever 49 which tions 41 andpivotally mounted on the elongate lever elements 32'and 40 at pin 50extending through portions 41. Pin 50 is mounted similarly to pin 52 inthat it engages in a corresponding recess or slot 51 in portion 39.Portion 39 is at this point provided with a lip 39 that may engage pin56 when arms 32 and 40 are separated to a predetermined position toprevent unnecessarily wide separation. Knife lever 49 is normally biasedto hold the stop 55 against the top wall of recess 62 by the flat leafspring 46. The spring 46 is engaged under tension betweenthe shouldersof recesses 44 and 44 in lever element 40 and jaw 61 respectively toexert pressure against the pin 48 carried by the lever 49. The pressureagainst pin 48 tends to rotate lever 49, the knife blade 54 and stop 55clockwise so that stop 55 is firmly seated in recess 62 and abuts thetop wall thereof in jaw 60. The spring 46 being tensed between the wallsof the respective recesses 44 and 44 and being restrained by pin 48tends to rotate jaws 60 and 61 towards each other whereby .a secureclamping pressure is applied for holding clamps 20 in position betweenthe jaws.

In FIGS. 2 and 3, front and side views of a clamp 20 are shown engagedin the jaws 60 and 61 of the dissector 30. It will be noted that theclamps 20 are each largely disc shaped with the circular outer periphery21 intercep'ted by a recess 22 extending beyond the point from which aradius is extended to periphery 21. In effect this leaves each clamp 20as formed by the respective areas between cords intercepting the are ofa circle and joined by the narrow wall portion 24 holding the twosegments 25 and 26 united. The foregoing is given by way of illustrationbut not by way of limitation, it being understood that the clamp membersmay be of other shapes having a slot extending inwardly from one edgefor entrance of the vessel to be strangled and which is deformable todiminish the slot and clamp the vessel therein. a a

The sides of the recess 22 are each provided with a series of teeth orserrations 27. Thus the pressure exerted on the outer periphery 21across one diameter by jaws 60 and 61 serves to force the segments 25and 26 towards each other to bring the teeth 27 into engagement with ablood vessel 70 therebetween somewhat as shown in FIGS. 5, 6 and 7. Theteeth 27 on one segment 25 engage between the teeth 27 on the othersegment 26 to provide a very restricting clamp on an artery of vein asindicated by the blood vessel 70. In the clamping position it will beseen that the clamp 20 assumes a lar'ge' ly oblate or elliptical shapeas the two segments 25 and 26 pivot towards each other about the inneredge of segment 24, which edge may be provided with slightly enlargedcutout portion 29 to facilitate this operation.

a The clamps 20 may be formed, for example, of a metal such as vitaliumor other metals found safe for use in surgery; said clamps may also beformed of materials which may be absorbed by the body or associatedtherewith for extended periods without toxic effect; or, for example,any one of a number of plastic, proteinaceous, albuminous, carbohydrate,cellulose ethers or esters and the like materials having desirablecharacteristics.

The dissector 30 is prepared for use in clamping and dissecting a bloodvessel 70 with clamp 20 in position of use. In brief, the finger grips34 and 42 are respectively engaged by a thumb and forefinger or indexfinger and the jaws 66 and 61 of the dissector brought into engage mentwith a desired blood vessel. As shown in FIGS. 2 and 3, the blood vessel70 is now within the confines of the V-shaped recess 22 in the pair ofclamps 20 held by the dissector. Pressure is applied from the fingers tothe lever elements 32 and 40 through the finger grips 34 and 42 to bringthe levers 32 and 40 towards each other. This movement is translated tothe jaws 69 and 61 to squeeze the clamp segments 25 and 26 towards eachother. As the pin 50 is not fixed in slot 53 with respect to jaw 61,extensive pressure may be exert ed on the clamps. During the movement ofelements 32 and 40, the rounded or beveled ends 43 on latch projections36 and 38 are engaged and cause a slight sideward or sen tional movementof the lever elements 34 and 42 which is permitted both by their lengthand because of the material used in their construction. This enables thesteps 37 and 37 on the latch element to become engaged in succession asthe. pressure on lever elements 32 and 40f continues. The respectivesteps 37 and 37 that are left in final engagement of course, isdetermined by how far the lever elements 32 and 40 are moved.

It will be'noted that as the pressure is applied the clamps 20 areoperated to bring the teeth or steps 27 on opposite walls of therecesses 22 into engagement to completely obstruct blood flow from theclamped portions of the vessel as maybe seen in FIGS. 5, 6, and 7. Atthat time, the clamps 20 assume an oblate or elliptical shape asindicated by the drawing in FIGS. 6 and 7 With the lever elements 32 and40 and jaws 60 and 61 latched in position, the forefinger or indexfinger may be: released'from finger grip 42 and'brought into engagement:with the depending portion 4% of lever arm 49 and a. slight pullingpressure exerted between them. The lever arm 49 is movedcounterclockwise thereby to carry the knife blade 54 into engagementwith the portion of the blood vessel between the two clamps 20 and severthe same.

As the circumferential or radial dimension of the clamps has beenconsiderably reduced, the opening of the jaws 60 and 61 will permittheir release therefrom. Thus the lever elements 32 and 40 are givenslight opposite sidewards or tortional movement to separate therespective engaged steps 37 and 37 on the latch projections 36 and 38and thereafter moved apart. The jaws 60 and 61 thus separate therebydisengaging from the clamps 20. The clamps 20 are left then clampedtightly over the respective severed ends of the blood vessel 70.

In accordance with the above, there has been shown and described hereina novel, useful, and extremely simple system arrangement for clampingand severing blood vessels which is capable of quick repeated operationwithout the need for excessive training or skill, but the particularembodiments described herein are not limitations upon other manners ofpracticing the invention.

We claim:

1. A dissector-obstructor for use in applying clamps and for severing asuccession of blood vessels, the improvement comprising a pair of jawshaving a common pivot and facing walls with spaced-apart recesses ineach wall, said recesses being aligned with a respective recess in theother facing wall for simultaneously engaging'a respective clamp betweeneach pair of aligned recesses, a knife blade and an arm pivotallycarried in association with one jaw for supporting said blade, meanscarried by said arm for biasing said jaws in opposing directions tosecurely engage each clamp, said means biasing said knife blade in thesame direction as the other jaw, and a lever arm for each jaw wherebysaid jaws are operable in their respective biased directions and saidknife blade arm is operable in opposition to its biased direction.

2. The arrangement claimed in claim 1, in which said pivot is engaged ina slot whereby it may be translated to permit the insertion of a clampbetween said jaws.

3. The arrangement claimed in claim 1, in which said knife blade islocated between said spaced apart recesses.

4. The arrangement claimed in claim 1 in which said one jaw has a recessin which said knife blade is engaged with one wall of said recessserving as a stop for said blade.

5. The arrangement claimed in claim 1 in which the other jaw has arecess for receiving said blade.

6. In a dissector-obstructor for use in applying clamps and for severinga succession of blood vessels, the improvement comprising a pair of jawshaving a common pivot and facing walls with laterally spaced apartrecesses in each wall, said recesses being aligned with a respectiverecess in the other facing wall for simultaneously engaging a respectiveclamp between each pair of aligned recesses, a knife blade and an armpivotally carried in association with one jaw for supporting said knifeblade for rocking movement between the laterally spaced apart recessesbetween retracted and operated positions, means for biasing said jaws inopposite directions to securely engage each clamp therebetween and forbiasing said knife blade toward retracted position, and a lever arm foreach jaw whereby said jaws are operable in their respective biasdirections and said knife blade arm is operable in opposition to itsbiased direction towards operated position.

References Cited in the file of this patent UNITED STATES PATENTS640,517 Acheson Jan. 2, 1900 828,094 Demo Aug. 7, 1906 1,854,582Ericksen Apr. 19, 1932 1,918,700 Harris July 18, 1933 1,973,569 KurtzSept. 11, 1934 2,052,870 Coco Sept. 1, 1936 2,060,724 Carroll Nov. 10,1936 2,320,460 Muller June 1, 1943 2,384,697 Riccardi Sept. 11, 19452,646,799 Jacoby July 28, 1953 2,819,818 Erdmann Jan. 14, 1958 3,006,344Vogelfanger Oct. 31, 1961

1. A DISSECTOR-OBSTRUCTOR FOR USE IN APPLYING CLAMPS AND FOR SEVERING ASUCCESSION OF BLOOD VESSELS, THE IMPROVEMENT COMPRISING A PAIR OF JAWSHAVING A COMMON PIVOT AND FACING WALLS WITH SPACED-APART RECESSES INEACH WALL, SAID RECESSES BEING ALIGNED WITH A RESPECTIVE RECESS IN THEOTHER FACING WALL FOR SIMULTANEOUSLY ENGAGING A RESPECTIVE CLAMP BETWEENEACH PAIR OF ALIGNED RECESSES, A KNIFE BLADE AND AN ARM PIVOTALLYCARRIED IN ASSOCIATION WITH ONE JAW FOR SUPPORTING SAID BLADE, MEANSCARRIED BY SAID ARM FOR BIASING SAID JAWS IN OPPOSING DIRECTIONS TOSECURELY ENGAGE EACH CLAMP, SAID MEANS BIASING SAID KNIFE BLADE IN THESAME DIRECTION AS THE OTHER JAW, AND